AccountId: 011433970860
ContactId: 58b513fb-fb87-498b-9e0f-95c20ce9074f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 398059 ms
Total Talk Time (AGENT): 139762 ms
Total Talk Time (CUSTOMER): 221783 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/58b513fb-fb87-498b-9e0f-95c20ce9074f_20250214T22:01_UTC.wav
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[AGENT][POSITIVE] Good afternoon.va speaking. May I help you?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Hi, my name is [PII], and I'm calling regarding a few claims that I filed. So I got, I got a letter that I'm missing some stuff.
[CUSTOMER][NEUTRAL] But I'm eating some stuff and I'm not sure what I should ask.
[CUSTOMER][NEUTRAL] The insurance to give me.
[AGENT][NEUTRAL] OK, um, and I apologize, your name is again?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and what is your policy number, please?
[CUSTOMER][NEUTRAL] I think
[CUSTOMER][NEUTRAL] Um, it's written on the letter you sent me, maybe? I don't have the card with me. Uh, I have the claim number. I have policy number. It's 0200.
[CUSTOMER][NEUTRAL] 3442.
[AGENT][NEUTRAL] OK, thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and verify your date of birth, mail address and email address for me, please.
[CUSTOMER][NEUTRAL] So it's [PII] and [PII], and [PII].
[AGENT][NEUTRAL] OK, and do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yeah, sure. It's [PII].
[AGENT][NEUTRAL] OK, you say you're calling about claims that process, uh, what is that claim number?
[CUSTOMER][NEUTRAL] Uh, so, I have Cater, which I'm not sure how it works. OK. First of all, the, uh, the first claim number, let's do the easier one. It's 356.
[CUSTOMER][NEUTRAL] 5 sorry, 356-0594.
[CUSTOMER][NEUTRAL] That's for me.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Uh, it looks like on this claim we're needing your primary insurance explanation of benefits or EOB.
[CUSTOMER][NEUTRAL] So I, I, I'm gonna call my insurance. I'm just, I wanna make sure I'm just gonna call them once and they're gonna send it to me because I sent the link which I guess was not enough. Uh, what I need to tell them to send me a PDF file with what?
[AGENT][NEUTRAL] For these two dates of service.
[AGENT][NEUTRAL] Um, the explanation of benefits or EOB, who is your primary insurance with?
[CUSTOMER][NEUTRAL] Florida Blue Cross Blue Shield.
[AGENT][NEUTRAL] OK, uh, with Florida Blue, uh, you can ask for health statements.
[AGENT][NEUTRAL] For that, for these two dates of service?
[CUSTOMER][NEUTRAL] I can ask from Florida Blue Cross Blue Shield for health statements from these two dates.
[AGENT][NEUTRAL] Yes, ma'am, for the [PII] and April, I'm sorry, [PII]. Yes, ma'am.
[CUSTOMER][NEUTRAL] In [PII], and [PII].
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Um, OK, so I need to call [PII].
[AGENT][NEUTRAL] Uh, [PII] at [PII]. Yes, ma'am.
[CUSTOMER][NEUTRAL] Yeah, [PII] and [PII]. So I need to call them and ask for health statement for these dates.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] That's for me. So that's enough for me. That's the only thing I'm missing, or I miss something else from them or from something else?
[AGENT][NEUTRAL] Uh, that's it.
[CUSTOMER][NEUTRAL] OK. Great. So I'm gonna call them. And the second thing is, so that's, but uh that's for both claims, right? Uh, one was for the city and the other one was for the schedule, whatever, the um emergency room. So that's for both claims will be enough, right?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK. OK. Now, the second one is for my son, [PII]. So I'll give you the claim number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it's 356-061-0.
[AGENT][NEUTRAL] Uh, for this claim, give me one moment.
[CUSTOMER][NEUTRAL] Mhm, yeah.
[AGENT][NEUTRAL] OK, it looks like they're needing the itemized bill, or well, they're needing diagnosis code and the primary EOB.
[AGENT][NEUTRAL] Um, I will say this with your primary insurance with Florida Blue, the health statements usually does have the diagnosis codes. So for his claims, uh, you can just request the health statements um for these two dates of service, [PII] and [PII], and then that satisfy what we need to process.
[CUSTOMER][NEUTRAL] Uh-huh, yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Ah, so I, for both things, I just need to talk to the insurance. I don't need to go back to the like uh the hospital where it happened. The hospital will give me all the information that I needed basically.
[AGENT][NEUTRAL] Yes, ma'am. On the Florida Blue there, um, EOBs are different than most insurance companies where they have the diagnosis codes, but those forms that they give are called health statements.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I have Florida Blue Cross Blue Shield. It's the same, right?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, fine. OK. So I need to ask from them or just so just basically for me and [PII] for these two dates. So [PII] is [PII] and [PII]. I need to ask for health statements for these dates. That's all.
[AGENT][NEUTRAL] Uh, yes, ma'am. [PII], other ones [PII].
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] [PII], I'm sorry about [PII], [PII]?
[AGENT][NEUTRAL] Yes, ma'am. [PII] and then [PII].
[CUSTOMER][NEUTRAL] Of [PII]? OK.
[CUSTOMER][POSITIVE] OK, great. Thank you so much. Thank you.
[AGENT][POSITIVE] Alright, you're welcome and thank you for calling APM Ms. [PII]. You have a great rest of your day.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, uh, oh yeah, I have, thank you. I just want one question. How I'm, so I'm gonna get it, uh, I'm, I hope, I hope it's gonna be fast. How I'm submitting do I need to send you a letter or just like I have a place on the, on the system, like after I'm logged in to add more files, there's a place there to add to the claim?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] If you're going to do it on the online service center, you would have to do it as a new claim.
[CUSTOMER][NEUTRAL] Oh, OK, so if I don't wanna do it, I guess, if I don't wanna do it to the new plan, I can just send you an, um, how I'm doing it. I'm sending you mail, like regular mail.
[AGENT][NEUTRAL] You can mail it or fax it, mhm.
[CUSTOMER][NEUTRAL] I can fax it? Oh, OK. Oh, so what's the fax?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]. So that's the fax or that or the uh mail I have the address here. OK, fine. Thank you so much. Thank you.
[AGENT][POSITIVE] Yes, ma'am. Thanks for calling APL. Have a great day. Bye.
[CUSTOMER][POSITIVE] Mhm thanks bye bye.